TB and HIV control in South Africa
HIV/AIDS can dramatically fuel the rate of tuberculosis (TB) infection. In South Africa, more than 18% of the population are infected with HIV/AIDS, and 1,000 people die from AIDS-related diseases each day. Two-thirds of those with HIV/AIDS also suffer from TB due to their weakened immune systems.
Dangerous drug-resistant strains of TB have now started to emerge. Mulitidrug Resistant Tuberculosis (MDR-TB) describes strains of TB that are resistant to the two main first-line TB drugs. Extensive Drug Resistant TB is MDR-TB that is also resistant to 3 or more of the 6 classes of second-line drugs. This strain of TB leaves patients virtually untreatable with current anti-TB drugs.
In the past few years, hundreds of people have died from extensive drug-resistant TB in South Africa. All provinces are affected.
Resistance to anti-TB drugs occurs as a result of incorrect drug prescribing practices, poor quality drugs or erratic supply of drugs, and non-adherence.
Non-adherence is particularly common. Treatment is long and complicated and drugs must be accompanied by nutritious food for 6 months. Many patients fail to stick to the treatment or stop taking it as soon as they feel better.
Community response to TB
In 2002, AMREF was requested to improve poorly functioning TB services in Sakhisizwe in the Chris Hani district, Eastern Cape Province.
In this district, local communities lacked knowledge of early TB detection and compliance with TB treatment. Health workers in Sakhisizwe were also poorly trained and failing to apply policies and guidelines for TB management and control.
In response, AMREF and its partners implemented a community-based program for TB prevention and management in Sakhisizwe. The program included training community health and development workers in TB awareness, prevention, and correct administration of treatments. It also involved training at least 40 health professionals in TB symptom detection, testing, treatment, monitoring and recording.
| By the end of the project, the community’s knowledge of TB had risen from 23% to 100%; adherence had increased and the TB cure rate had risen from 20 to 55% |
Need to integrate HIV and TB services
The project identified a need to:
- Integrate HIV/AIDS voluntary counseling and testing (VCT) with TB services in the area
- Build the capacity of VCT service providers to test for TB
- Strengthen VCT referral to TB treatment and support services
In response, AMREF has recently established a project in South Africa’s Eastern Cape Province. The project aims to strengthen HIV/AIDS voluntary counseling and testing (VCT) services and to improve the referral system between VCT and TB services.
In its first year, the project will train at least 70 staff at existing VCT centers in TB symptoms, TB testing referrals, and the links between TB and HIV/AIDS.
A significant number of community health personnel will also be taught in:
- Counseling TB patients on the need for VCT
- Counseling HIV patients on the need for TB testing
- Mobilizing and motivating patients to go for TB testing
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